Doctors pay more despite new law

http://www.enquirer.com/editions/2004/10/11/loc_doctor.day2.html

When Ohio lawmakers limited the amount of money that patients can collect for medical malpractice, they expected soaring malpractice insurance rates to fall.

Doctors would quit threatening to leave the state. Ohioans would get quality care at more reasonable costs.

But more than a year after the malpractice cap took effect, doctors are paying more for coverage than ever. Obstetrics doctors paid up to $89,000 last year; surgeons, $68,000. Some doctors are paying more than 25 percent of their gross incomes for malpractice insurance, they say.

Insurers say rates won't come down until the new law proves it can stand up in court.

"I cannot overemphasize the critical role the Ohio courts will play in this issue," says Paul Brutus, a top executive with the Medical Assurance Co., one of the state's five major malpractice insurers.

This is why doctors have launched an aggressive campaign to elect Ohio Supreme Court members who they hope will uphold the cap. Four seats on the seven-member court will be decided Nov. 2.

In April 2003, Ohio enacted a $350,000 cap on non-economic damages in most malpractice cases, such as awards for pain and suffering.

Having a damage cap was supposed to reduce insurance rates for doctors by allowing insurers to better predict their potential losses. But depending on their specialty and the insurer involved, doctors in Ohio have seen rate increases ranging from 10 percent to 87 percent or more in 2003 and 2004.

More rate increases are expected for 2005. And all these increases are for doctors who haven't been hit with a verdict or a settlement against them.

The financial sting caused by the rising insurance rates has generated deep, widely shared anger among physicians.

"We have some good legislation that has been passed, yet the rates haven't dropped," says Dr. Molly Katz, a former president of the Academy of Medicine of Cincinnati. "Many physicians are frustrated and impatient."

October 9, 2004

Saddam Hussein saw his life as an unfolding epic narrative, with retreats and advances, but always the same ending. He would go down in history as the glorious Arab leader, as the Saladin of his day. One thousand years from now, schoolchildren would look back and marvel at the life of The Struggler, the great leader whose life was one of incessant strife, but who restored the greatness of the Arab nation.

They would look back and see the man who lived by his saying: "We will never lower our heads as long as we live, even if we have to destroy everybody." Charles Duelfer opened his report on Iraqi weapons of mass destruction with those words. For a humiliated people, Saddam would restore pride by any means.

Saddam knew the tools he would need to reshape history and establish his glory: weapons of mass destruction. These weapons had what Duelfer and his team called a "totemic" importance to him. With these weapons, Saddam had defeated the evil Persians. With these weapons he had crushed his internal opponents. With these weapons he would deter what he called the "Zionist octopus" in both Israel and America.

But in the 1990's, the world was arrayed against him to deprive him of these weapons. So Saddam, the clever one, The Struggler, undertook a tactical retreat. He would destroy the weapons while preserving his capacities to make them later. He would foil the inspectors and divide the international community. He would induce it to end the sanctions it had imposed to pen him in. Then, when the sanctions were lifted, he would reconstitute his weapons and emerge greater and mightier than before.

The world lacked what Saddam had: the long perspective. Saddam understood that what others see as a defeat or a setback can really be a glorious victory if it is seen in the context of the longer epic.

Saddam worked patiently to undermine the sanctions. He stored the corpses of babies in great piles, and then unveiled them all at once in great processions to illustrate the great humanitarian horrors of the sanctions.

Saddam personally made up a list of officials at the U.N., in France, in Russia and elsewhere who would be bribed. He sent out his oil ministers to curry favor with China, France, Turkey and Russia. He established illicit trading relations with Ukraine, Syria, North Korea and other nations to rebuild his arsenal.

It was all working. He acquired about $11 billion through illicit trading. He used the oil-for-food billions to build palaces. His oil minister was treated as a "rock star," as the report put it, at international events, so thick was the lust to trade with Iraq.

France, Russia, China and other nations lobbied to lift sanctions. Saddam was, as the Duelfer report noted, "palpably close" to ending sanctions.

With sanctions weakening and money flowing, he rebuilt his strength. He contacted W.M.D. scientists in Russia, Belarus, Bulgaria and elsewhere to enhance his technical knowledge base. He increased the funds for his nuclear scientists. He increased his military-industrial-complex's budget 40-fold between 1996 and 2002. He increased the number of technical research projects to 3,200 from 40. As Duelfer reports, "Prohibited goods and weapons were being shipped into Iraq with virtually no problem."

And that is where Duelfer's story ends. Duelfer makes clear on the very first page of his report that it is a story. It is a mistake and a distortion, he writes, to pick out a single frame of the movie and isolate it from the rest of the tale.

But that is exactly what has happened. I have never in my life seen a government report so distorted by partisan passions. The fact that Saddam had no W.M.D. in 2001 has been amply reported, but it's been isolated from the more important and complicated fact of Saddam's nature and intent.

But we know where things were headed. Sanctions would have been lifted. Saddam, rich, triumphant and unbalanced, would have reconstituted his W.M.D. Perhaps he would have joined a nuclear arms race with Iran. Perhaps he would have left it all to his pathological heir Qusay.

We can argue about what would have been the best way to depose Saddam, but this report makes it crystal clear that this insatiable tyrant needed to be deposed. He was the menace, and, as the world dithered, he was winning his struggle. He was on the verge of greatness. We would all now be living in his nightmare.

Oct. 7, 2004, 6:08AM

AP MINNEAPOLIS - A Minnesota health insurer says it won't pay the bill when doctors make serious mistakes, apparently the first time an insurer has taken such a hard-line stand against medical errors.

HealthPartners, which has 630,000 customers, said its contracts won't allow the hospital to bill the patient for the unpaid amount.

HealthPartners, Minnesota's third-largest health insurer, said it's not trying to save money but wants to send a message to get doctors to take medical mistakes seriously.

"This is about reinforcing accountability. We want to make sure that no person that experiences one of these events, as terrible and tragic as they are, has to suffer additionally by being billed for them," said Dr. George Isham, HealthPartners medical director.

Some doctors didn't see it that way.
"He can say whatever he wants to say. What it really is about is HealthPartners not paying for medical care," said Dr. Michael Gonzalez-Campoy, president of the Minnesota Medical Association.

"To penalize financially individuals that, in his mind, are making mistakes is something that doesn't happen in any other industry," Gonzalez-Campoy said.

In a 1999 report, the Institute of Medicine estimated that 44,000 to 98,000 Americans die annually because of medical mistakes. Since then, Minnesota and Connecticut are the only two states that have adopted laws requiring hospitals to report serious mistakes.

In recent days, attention has been focused on some remarks I've made about Iraq. The coverage of these remarks has elicited far more heat than light, so I believe it's important to put my remarks in the correct context.

In my speeches, I have said that the United States paid a price for not stopping the looting in Iraq in the immediate aftermath of major combat operations and that we did not have enough troops on the ground to accomplish that task. The press and critics of the war have seized on these remarks in an effort to undermine President Bush's Iraq policy.

This effort won't succeed. Let me explain why.

It's no secret that during my time in Iraq I had tactical disagreements with others, including military commanders on the ground. Such disagreements among individuals of good will happen all the time, particularly in war and postwar situations. I believe it would have been helpful to have had more troops early on to stop the looting that did so much damage to Iraq's already decrepit infrastructure. The military commanders believed we had enough American troops in Iraq and that having a larger American military presence would have been counterproductive because it would have alienated Iraqis. That was a reasonable point of view, and it may have been right. The truth is that we'll never know.

But during the 14 months I was in Iraq, the administration, the military and I all agreed that the coalition's top priority was a broad, sustained effort to train Iraqis to take more responsibility for their own security. This effort, financed in large measure by the emergency supplemental budget approved by Congress last year, continues today. In the end, Iraq's security must depend on Iraqis.

Our troops continue to work closely with Iraqis to isolate and destroy terrorist strongholds. And the United States is supporting Prime Minister Ayad Allawi in his determined effort to bring security and democracy to Iraq. Elections will be held in January and, though there will be challenges and hardships, progress is being made. For the task before us now, I believe we have enough troops in Iraq.

The press has been curiously reluctant to report my constant public support for the president's strategy in Iraq and his policies to fight terrorism. I have been involved in the war on terrorism for two decades, and in my view no world leader has better understood the stakes in this global war than President Bush.

The president was right when he concluded that Saddam Hussein was a menace who needed to be removed from power. He understands that our enemies are not confined to Al Qaeda, and certainly not just to Osama bin Laden, who is probably trapped in his hide-out in Afghanistan. As the bipartisan 9/11 commission reported, there were contacts between Al Qaeda and Saddam Hussein's regime going back a decade. We will win the war against global terror only by staying on the offensive and confronting terrorists and state sponsors of terror - wherever they are. Right now, Abu Musab al-Zarqawi, a Qaeda ally, is a dangerous threat. He is in Iraq.

President Bush has said that Iraq is the central front in the war on terror. He is right. Mr. Zarqawi's stated goal is to kill Americans, set off a sectarian war in Iraq and defeat democracy there. He is our enemy.

Our victory also depends on devoting the resources necessary to win this war. So last year, President Bush asked the American people to make available $87 billion for military and reconstruction operations in Iraq and Afghanistan. The military commanders and I strongly agreed on the importance of these funds, which is why we stood together before Congress to make the case for their approval. The overwhelming majority of Congress understood and provided the funds needed to fight the war and win the peace in Iraq and Afghanistan. These were vital resources that Senator John Kerry voted to deny our troops.

Mr. Kerry is free to quote my comments about Iraq. But for the sake of honesty he should also point out that I have repeatedly said, including in all my speeches in recent weeks, that President Bush made a correct and courageous decision to liberate Iraq from Saddam Hussein's brutality, and that the president is correct to see the war in Iraq as a central front in the war on terrorism.

A year and a half ago, President Bush asked me to come to the Oval Office to discuss my going to Iraq to head the coalition authority. He asked me bluntly, "Why would you want to leave private life and take on such a difficult, dangerous and probably thankless job?" Without hesitation, I answered, "Because I believe in your vision for Iraq and would be honored to help you make it a reality." Today America and the coalition are making steady progress toward that vision.

L. Paul Bremer III, former chairman of the National Commission on Terrorism, was the administrator of the Coalition Provisional Authority in Iraq from May 2003 to June 2004.

A well-balanced article from the LA Times on medical malpractice cases by Amitai Etzioni.

Excerpt: "...the truth is, there aren't too many civil lawsuits; there are too few. Take medical malpractice. The American Medical Assn. warns us that million-dollar jury awards and a flood of frivolous lawsuits are increasing the cost of doctors' insurance and creating a "full-blown liability crisis." But for every patient who sues, there are severalwho should but don't.

A 1990 Harvard University study found that only one out of eight patients who had a valid medical malpractice claim actually filed a suit. The study examined the records of more than 30,000 patients in New York — one of the nation's most litigious states — and discovered that in 1984 nearly 13,000 cases supported by "strong or certain evidence of negligence" were never pursued in court.

The Harvard study found that 3.7% of all patients suffered from complications caused by doctors. Later studies have found that number to be as high as 17.7%. Among the complications cited: the surgical removal of the wrong leg or kidney, brain damage to newborns and transplant procedures that didn't properly match donor and recipient.

In 2000, the National Academy of Sciences' Institute of Medicine found that between 44,000 and 98,000 patients died every year because of mistakes made by doctors and other healthcare personnel."

The doctors are being financially squeezed by reduced payments from Medicare and other insurance, while at the same time their malpractice insurance premiums are rising drastically. Limiting the constitutional rights of injured parties is not the answer to those problems.

The fallout over removing the drug will not be as bad as the fen-phen case, lawyers say.
The flood of phone calls to plaintiffs' lawyers began soon after pharmaceutical giant Merck & Co. Inc. announced Thursday that it would withdraw its painkiller Vioxx from the market because of safety concerns.

But just how bad will the legal fallout get for the Whitehouse Station, N.J., drugmaker?

Merck is bracing for an onslaught of lawsuits, but some analysts - and even some lawyers who represent Vioxx patients - doubt that the company faces anything on the scale of the failed diet-drug combination known as fen-phen.

More than 100,000 lawsuits were filed by patients saying they were injured by fen-phen. The massive litigation has cost Madison, N.J.-based Wyeth $16.6 billion so far.

"Our preliminary estimate is that about 16,632 people may ultimately file a legitimate lawsuit" against Merck over Vioxx, analyst Tim Anderson wrote in a report issued yesterday by the Prudential Equity Group.

"We do not expect the liability to blossom into anything remotely close to fen-phen," he added.

Even before Merck's Vioxx withdrawal announcement, several hundred suits had been filed against the company by users of the arthritis pain medicine, including 175 in New Jersey.

"The number of cases will be growing exponentially," said Andy Birchfield, a Montgomery, Ala., lawyer who has filed 58 Vioxx suits. About half involve the families of people who died from heart attacks or strokes while on the arthritis pain medicine, Birchfield said.

"I think you will have a lot of people now going back and recognizing that, when I had my heart attack or when my mom or dad had a heart attack, they were taking Vioxx," he said. "We have received a tremendous number of calls" during the last two days.

Not 'as big as fen-phen'
Even so, some lawyers do not see Vioxx litigation growing to rival fen-phen, at least in number.

"I don't think it is as big as fen-phen," said Sol H. Weiss, a Philadelphia lawyer representing dozens of Vioxx users, including some who died while on the drug.

Weiss, who also represents fen-phen users, said there would likely be fewer Vioxx cases because the drug leaves the body relatively quickly and does not appear to cause lasting damage unless a patient suffers a heart attack or stroke while taking it.

"Right now, the science looks like if you are going to have a Vioxx event, it will occur while you are on the drug," said Christopher A. Seeger, a New York lawyer who represents more than 300 people who allegedly suffered a Vioxx-related heart attacks or strokes.

Shanin Specter, a Philadelphia lawyer involved in Vioxx cases, said that while there might be a more limited number of cases, the damages collected by successful plaintiffs will likely to be bigger than fen-phen.

"The vast bulk of fen-phen users had less significant injuries than a heart attack or a stroke," Specter said.

The first Vioxx cases could go to trial at the end of this year or early next year. It is too early to estimate the ultimate cost to the company in legal fees and potential damages. However, some lawyers say it could be similar to litigation faced by Bayer AG over its cholesterol-lowering Baycol, which cost that company more than $1 billion.

Merck: Not sure of liability
"It is not possible at this time to reasonably estimate the company's potential liability," said Merck spokesman Tony Plohoros in a statement yesterday. "A series of highly unfavorable outcomes... could have a material adverse effect on the company's financial position."

Plohoros and other company officials declined to disclose how much money Merck would put in reserve to cover potential losses.

Until Thursday, Merck had consistently defended Vioxx in the face of studies that suggested links with cardiovascular problems.

The company said it was withdrawing Vioxx from the market because a new study had revealed the drug doubled the risk of heart attacks and strokes in patients who took the drug daily for more than 18 months.

Despite the study's findings, plaintiffs' and defense lawyers agreed it was still necessary to show a link between the injury and use of the drug.

"There have been cases that we have evaluated and turned down where we could not find the strong connection between Vioxx and the heart attack," Birchfield, the Alabama lawyer, said.

About 20 million people have taken Vioxx since it was introduced in the United States in 1999, the company estimates. The company said it was unclear how many of those people had used the drug regularly for more than 18 months.

Vioxx generated $2.5 billion in worldwide sales a year - 11 percent of the company's total.

The front page of today’s Salem News is a prime example of media bias in reporting "the news". The article should have been on the editorial page, not the front page, in light of the substantial commentary and editorial selectivity of the AP writer. My comments are in capital letters.

Lead paragraph:
"Sen. John Kerry campaigned Sunday for votes in this Democratic stronghold of Ohio [Austintown], where he is still struggling to break ahead [EDITORIAL ASSUMPTION: HE WILL OR SHOULD BREAK AHEAD?] despite massive job losses under President Bush. [AN EDITORIAL COMMENT STRAIGHT FROM THE KERRY PLAYBOOK, WITHOUT SUBSTANTIATION, AND JUXTAPOSED TO ATTRIBUTE ALL BLAME FOR ANY JOB LOSS ON BUSH.]
Second paragraph:
"Kerry has visited Ohio at least 18 times this year, more than any other state [MAY BE TRUE, BUT IMPLICATION THAT HE REALLY CARES ABOUT US], and he returned to Mahoning County to stake claim to what should be solid support." [POLITICAL ANALYSIS, NOT REPORTING]
Fifteen paragraphs into the story, the author (I won’t call him or her a reporter) quotes the Bush campaign statement that "all of Kerry’s promises will lead to higher taxes for all Americans."
The last paragraph is perhaps the most editorial:
"The latest polls of Ohio voters show Bush and Kerry are in a dead heat."[NEWSDAY COLUMNIST JIMMY BRESLIN HAS THIS TO SAY ABOUT POLLS: "ANYBODY WHO BELIEVES THESE NATIONAL POLITICAL POLLS ARE GIVING YOU FACTS IS A GULLIBLE FOOL. ANY EDITORS OF NEWSPAPERS OR TELEVISION NEWS SHOWS WHO USE POLL RESULTS AS A STORY ARE BEYOND GULLIBLE. ON BEHALF OF THE PUBLIC THEY PROFESS TO SERVE, THEY ARE INDOLENT SALESMEN OF FALSEHOODS." http://www.newsday.com/news/local/newyork/columnists/ny-nybres163973220sep16,0,5538561.column]

Continuing on with the article:
"Still, Ohio and Florida remain Kerry’s best opportunities to win electoral votes that went to Bush four years ago." [POLITICAL COMMENTARY, NOT REPORTING - PERHAPS A SUBTLE INDICATION OF THE WRITER’S WISH LIST?]

And the final editorial subtleness [local rather than Associated Press] is the placement of the entire article on the front page, rather than with the editorials.

Our schools are teaching our students to read with discernment; the least we as voters can do is the same.